diagnosis. The underlying etiology is not fully understood; however, it has been linked to Helicobacter pylori gastritis and gastric cancer. GX in the pediatric population is largely unreported in the literature. Because of the relative rarity, documentation with case reports are essential to provide as much data as possible to see if there is a correlation between GX and malignant potential in the pediatric population. Our group is reporting two cases, a 10-year-old male and a 7-year-old male, both who presented with chronic dysphagia, upper abdominal pain, nausea, vomiting, and loss of appetite. Upper endoscopies for both patients revealed small polypoid lesions located in the antrum with foamy histiocytes on histology, leading to the diagnosis of gastric xanthoma.]]>
Abdominal Pain ; Adult ; Appetite ; Child ; Deglutition Disorders ; Diagnosis ; Endoscopy ; Gastritis ; Helicobacter pylori ; Histiocytes ; Humans ; Incidental Findings ; Male ; Nausea ; Pediatrics ; Stomach Neoplasms ; Vomiting ; Xanthomatosis

OBJECTIVE: To analyze the causes of the esophagogastric junction outlet obstruction (EGJOO) patients, to discuss the differences of the clinical manifestation and esophageal motility characteristics between the anatomic EGJOO (A-EGJOO) and functional EGJOO (F-EGJOO) subgroups, and to search the diagnostic values of the specific metrics for differentiating the subgroups of EGJOO patients. METHODS: For the current retrospective study, all the patients who underwent the esophageal high resonance manometry test were retrospectively analyzed from Jan 2012 to Oct 2018 in Peking University Third Hospital. The EGJOO patients were enrolled in the following research. The clinical characteristics, such as symptoms and causes of the patients were studied. Then the patients were divided into two subgroups as A-EGJOO subgroup and F-EGJOO subgroup. The clinical symptoms and the main manometry metrics were compared between these two subgroups. The significant different metrics between the two groups were selected to draw receiver operating characteristic (ROC) curves and the diagnostic values were analyzed in differentiating the A-EGJOO and F-EGJOO subgroups. RESULTS: The most common symptom of EGJOO was chest pain or chest discomfort (30.63%), then the dysphagia (29.73%), and acid regurgitation/heartburn (27.03%). Non-erosive reflux disease (36.04%) was the most popular cause for EGJOO, then the reflux esophagitis (17.12%). Besides the intra-EGJOO and extra-EGJOO lesions, the connective tissue disease (6.31%) and central nervous diseases (2.70%) were found to be the etiology of EGJOO. The causes of the rest 19 EGJOO were unknown. A-EGJOO patients presented significantly higher intra bolus pressure (IBP) than that of F-EGJOO [6.80 (5.20, 9.20) mmHg vs. 5.10 (3.10, 7.60) mmHg, P=0.016]. The area under curve of IBP was 0.637. When IBP≥5.15 mmHg, the sensitivity was 78.60% and specificity 50.70% to differentiate A- or F-EGJOO. CONCLUSION Chest pain or chest discomfort was the most common symptom in EGJOO patients. Besides the intraluminal structural disorders, the extra-luminal causes were found in EGJOO patients. A-EGJOO presented higher IBP than that of F-EGJOO patients. The cutoff value of IBP to differentiate A-EGJOO from EGJOO was 5.15 mmHg with sensitivity 78.06% and specificity 50.70%. However for the low area under curve, the diagnostic value of IBP was limited.
Deglutition Disorders ; Esophageal Motility Disorders/diagnosis* ; Esophagogastric Junction ; Humans ; Manometry ; Retrospective Studies

Barium sulfate is commonly used to prepare contrast media for videofluorograpy. The flow characteristics of thickened liquids formulated for oropharyngeal imaging are known to be greatly affected by the addition of barium. In this study, thickened barium liquids were prepared by mixing a commercial xanthan gum (XG)-based thickener (Visco-up®) at different concentrations (0.1%–3.0%) with barium powder (Baritop HD®), and differences in the viscosity between thickened non-barium and thickened barium liquids were investigated. In addition, the thickness levels of thickened barium liquids, which are based on the National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI) guidelines, were classified by measuring the viscosity (NDD) and gravity flow through a syringe (IDDSI) with 0.1%–3.0% thickener concentrations. The apparent viscosity (η(a),₅₀) values of thickened barium liquids were much higher than those of thickened non-barium liquids, indicating that the addition of barium to the XG-based thickener resulted in further thickening. Standard recipes for preparing thickened barium liquids with desirable thickness levels were also established, showing the different thickener concentrations corresponding to the different NDD and IDDSI levels.
Aphasia ; Barium Sulfate ; Barium ; Contrast Media ; Deglutition Disorders ; Diagnosis ; Diet ; Gingiva ; Gravitation ; Syringes ; Viscosity

BACKGROUND/AIMS: The epidemiology and pathogenesis of eosinophilic esophagitis (EoE) remain unclear in Asian countries. We investigated clinicopathological characteristics and diagnostic trends of EoE, and evaluated 3 tissue biomarkers for correlation with disease activity and treatment response in Korean patients with EoE. METHODS: We retrospectively reviewed 25 271 esophageal biopsies performed during upper endoscopies between 2006 and 2017. We diagnosed EoE based on ≥ 15 eosinophils/high-power field (HPF) and, symptoms of esophageal dysfunction. We performed immunohistochemical analysis for tryptase, eosinophilic derived neurotoxin (EDN), and eotaxin-3. RESULTS: We diagnosed EoE in 72 patients (53 men and 19 women; mean age, 46.2 years) with presenting symptoms of, dysphagia (15.3%), epigastric pain (31.9%), and heartburn (30.6%). The diagnostic rate of EoE considerably increased between 2006 and 2017, from 0.29 diagnoses to 7.99 diagnoses per 1000 esophageal biopsies (P < 0.001). The mean peak eosinophil count (PEC) was 56.0 (± 77.8)/HPF. Whereas the EDN (rho = 0.667, P < 0.001) and eotaxin-3 levels (rho = 0.465, P < 0.001) correlated with PEC, tryptase and PEC were weakly correlated (rho = 0.291, P = 0.013). EDN (rho = 0.279, P = 0.017), and tryptase (rho = 0.279, P = 0.033) correlated with the inflammatory score of Eosinophilic Esophagitis Endoscopic Reference Score. Immunohistochemical analysis and changes in tryptase, EDN, and eotaxin-3 levels were associated with histologic and endoscopic improvements. CONCLUSIONS: EoE incidence considerably increased during the 12-year period, regardless of endoscopic esophageal biopsy rate. Tryptase, EDN, and eotaxin-3 levels in esophageal biopsy specimens could be promising biomarkers for disease activity, symptom, and endoscopic response in Korea.
Asian Continental Ancestry Group ; Biomarkers ; Biopsy ; Deglutition Disorders ; Diagnosis ; Endoscopy ; Eosinophilic Esophagitis ; Eosinophils ; Epidemiology ; Esophagus ; Female ; Heartburn ; Humans ; Incidence ; Korea ; Male ; Retrospective Studies ; Tryptases

Swallowing can be affected by a variety of systemic diseases. The etiology of dysphagia in the geriatric population is usually overlooked due mainly to a presumed diagnosis of presbyphagia or difficulty in revealing the direct cause. On the other hand, dysphagia can be a meaningful clinical sign of premalignant systemic disease. A 78-year-old man, without any prior medical or family history, was admitted with the chief complaint of dysphagia with recent aspiration pneumonia. Instrumental swallowing tests revealed a severe degree of dysphagia due to decreased laryngopharyngeal sensation and weakness of the pharyngeal constrictor muscles. Extensive workup, including electromyography and laboratory tests, revealed severe sensorimotor peripheral polyneuropathy related to monoclonal gammopathy. Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant precursor of multiple myeloma, which is characterized by the proliferation of monoclonal proteins. These conditions are often associated with peripheral polyneuropathy, ataxia, and sometimes even muscle weakness. Although dysphagia can occur in other systemic disorders, such as vasculitis or paraneoplastic syndrome-related malignancies, there are few reports of dysphagia related to MGUS. The patient was followed up for three years. The MGUS showed no further progression, but the patient showed no improvement, indicating a protracted clinical course and poor prognosis when dysphagia is related to MGUS.
Aged ; Ataxia ; Deglutition ; Deglutition Disorders ; Diagnosis ; Electromyography ; Hand ; Humans ; Monoclonal Gammopathy of Undetermined Significance ; Multiple Myeloma ; Muscle Weakness ; Muscles ; Paraproteinemias ; Pneumonia, Aspiration ; Polyneuropathies ; Prognosis ; Sensation ; Vasculitis

Aspiration is the entry of materials, such as pharyngeal secretions, food, or stomach contents, into the respiratory system. Dysphagia is the most common risk factor of aspiration, but there are many other risk factors. A single factor or multiple factors may be present to induce the aspiration, and the risk factors of aspiration should be considered multidimensional. The bedside water test is suitable as a screening test for an evaluation of aspiration. Videofluoroscopic swallowing study and flexible endoscopic evaluation of swallowing are the diagnostic tests of aspiration and the tests are required if the screening test shows signs of aspiration or silent aspiration is strongly suspected. The diagnostic test should assess not only the presence of aspiration, but also the pathophysiologic risk factors of aspiration.
Deglutition ; Deglutition Disorders ; Diagnosis ; Diagnostic Tests, Routine ; Gastrointestinal Contents ; Mass Screening ; Respiratory Aspiration ; Respiratory System ; Risk Factors ; Water

A 43-year-old woman suffered from drooling and dysphagia after a stroke in the left posterior inferior cerebellar artery territory. Videofluoroscopic swallowing study showed compatible findings of cricopharyngeal dysphagia. Despite the injection of botulinum neurotoxin, no symptom improvement was achieved and pharyngeal dystonia was considered as the cause. Medications for dystonia dramatically helped with saliva control and resulted in a small improvement in the progression of food from the pharyngeal to esophageal phase. After adjusting the drug dose, the patient was able to perform social activities without drooling. Moreover, she could consume food orally; however, this was limited to small amounts of liquid, and the main method of nutrition support was via an orogastric tube. Therefore, we suggest that physicians should make a differential diagnosis of combined dystonia in patients complaining of dysphagia by esophageal manometry and electromyography.
Adult ; Arteries ; Deglutition ; Deglutition Disorders ; Diagnosis, Differential ; Drug Therapy ; Dystonia ; Electromyography ; Female ; Humans ; Manometry ; Methods ; Saliva ; Sialorrhea ; Stroke

Lichen planus (LP) is a chronic mucocutaneous inflammatory condition that typically affects middle-aged adults. Esophageal involvement in LP is rare and underrecognized, often leading to delayed diagnosis and treatment of LP. Herein, we describe three cases of esophageal LP (ELP) in clinically symptomatic patients with endoscopic lesions in the upper to mid-esophagus. This case series suggests that ELP is be more common than was previously thought and emphasizes that clinicians should have a high index of suspicion for this diagnosis, particularly when evaluating proximal esophageal lesions in patients presenting with dysphagia. The series also highlights the successful treatment of our patients with budesonide-honey slurry.
Adult ; Deglutition Disorders ; Delayed Diagnosis ; Diagnosis ; Humans ; Lichen Planus ; Lichenoid Eruptions ; Lichens ; Skin Diseases, Papulosquamous

Historically, Eagle syndrome is a term that has been used to describe radiating pain in the orofacial region, foreign body sensation, and/or dysphagia due to a unilateral or bilateral elongated styloid process impinging upon the tonsillar region. Because elongated styloid processes–with or without associated Eagle syndrome–can present with various symptoms and radiographic findings, it can be challenging for healthcare practitioners to formulate an accurate diagnosis. Abnormal styloid anatomy can lead to a multitude of symptoms, including chronic orofacial/neck pain, thus masquerading as more commonly diagnosed conditions. In this report, we describe a patient who presented to our department with styloid process elongation and fracture. A careful history, physical examination, and a conebeam computed tomography (CBCT) investigation led to the diagnosis. The patient was then referred for appropriate care. This case report demonstrates the utilization of CBCT in differentiating a fracture site from a pseudo-joint that might mimic a fracture.
Cone-Beam Computed Tomography ; Deglutition Disorders ; Delivery of Health Care ; Diagnosis ; Eagles ; Foreign Bodies ; Humans ; Neck Pain ; Neck ; Physical Examination ; Sensation

Congenital esophageal stenosis (CES) is a rare disease that has been reported to occur once in every 25,000 to 50,000 births. According to its etiology, CES is divided into 3 subtypes, tracheobronchial remnants (TBR), fibromuscular hypertrophy (FMH) and membranous diaphragm (MD). Symptoms begin at the weaning period and the introduction of solid food around 6 months with dysphagia and vomiting. Esophagography is first screening test and endoscopic ultrasonography plays important roles to diagnose subtypes deciding therapeutic plan. TBRs were generally treated with surgical resection and end-to-end anasotomosis, whereas FMH and MD had good response rate to endoscopic or radiologic guided dilatation. This article reviews the literature on the etiology, clinical course, diagnosis and management of CES including recent opinion.
Child ; Deglutition Disorders ; Diagnosis ; Diaphragm ; Dilatation ; Endosonography ; Esophageal Stenosis ; Esophagus ; Humans ; Hypertrophy ; Mass Screening ; Parturition ; Prognosis ; Rare Diseases ; Vomiting ; Weaning